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Tracking Dengue: An Interview With Alisa Aliaga-Samanez

The rapid spread of Dengue could lead to a global pandemic, and so the geographical extent of this spread needs to be assessed and predicted. There are also reasons to suggest that transmission of Dengue from non-human primates in tropical forest cycles is being underestimated.

Alisa Aliaga-Samanez sitting by the computer
Alisa Aliaga-Samanez

 

Exactly one month ago, on June 7th, PLOS Neglected Tropical Diseases published a research article Worldwide dynamic biogeography of zoonotic and anthroponotic Dengue. The study is the first high-resolution analysis of how the risk of Dengue transmission has been changing geographically since the late 20th century, indicating the virus (DENV) has been making a home in previously low-risk areas, potentially due to global warming and deforestation. 

We spoke with the corresponding author Alisa Aliaga-Samanez, who worked alongside Marina Cobos-Mayo, Raimundo Real, Marina Segura, David Romero, Julia E. Fa, and Jesús Olivero, to learn more about the importance of this study and her experience working with GIDEON data. 

 

How did you find out about GIDEON?  

We got to know GIDEON thanks to an article published in PNAS by Kris A. Murray and colleagues entitled “Global biogeography of human infectious diseases.”

 

What were the reasons behind choosing the GIDEON database as one of your data sources?

We know that GIDEON is one of the most complete data sources worldwide on zoonoses, so we wanted to use it to build our database. For that reason, the project where I work at the University of Malaga funded our access to GIDEON.

 

What is the importance of biogeography studies like this one to public health management?  

Biogeographical studies, through modeling, applied to pathogens, allow us to understand the distribution of infectious diseases. The occurrence of disease cases is related to social factors but also to environmental variables that determine the degree to which certain environments favor the occurrence of disease, even where it has not been recorded. Thanks to the tool we use in our study, we are able to propose different management strategies depending on which factors favor the risk of transmission in different regions of the world. We took into account three possible biogeographical scenarios related to Dengue transmission risk: (1) zones with favorable conditions for viruses and vectors, (2) favorable conditions for virus only, and (3) favorable conditions for vectors only. Besides, our biogeographical approach helped us to analyze the extent of the areas where non-human primates could be involved in sylvatic Dengue cycles.

 

What is the importance of biogeography studies like this one to public health management?  

Biogeographical studies, through modeling, applied to pathogens, allow us to understand the distribution of infectious diseases. The occurrence of disease cases is related to social factors but also to environmental variables that determine the degree to which certain environments favor the occurrence of disease, even where it has not been recorded. Thanks to the tool we use in our study, we are able to propose different management strategies depending on which factors favor the risk of transmission in different regions of the world. We took into account three possible biogeographical scenarios related to Dengue transmission risk: (1) zones with favorable conditions for viruses and vectors, (2) favorable conditions for virus only, and (3) favorable conditions for vectors only. Besides, our biogeographical approach helped us to analyze the extent of the areas where non-human primates could be involved in sylvatic Dengue cycles.

 

Do you believe the risks of the Dengue pandemic are exacerbated by global warming?  

We think global warming may be one of the factors that could be favoring vectors to adapt to new environments. A study published by Messina and colleagues in 2019 concluded that the World’s population at risk of Dengue could experience an almost 60% increase by 2080. In addition, they suggested that outbreaks could reach areas in continents such as Australia, Argentina, Japan, eastern China, and southern Europe.

Melting ice
Photo by William Bossen on Unsplash

 

In your experience, how effective study such as yours at influencing change in government and health policies, and do you think work like this will be taken more seriously following the COVID-19 pandemic?  

We have seen that governmental bodies such as WHO or CDC rely on scientific studies to manage risk areas, but we feel that this work is being limited in Africa, for example. On the other hand, some diseases already have a vaccine available, such as yellow fever, but its application might not be well managed in some African countries, where large outbreaks occur. In the case of Dengue, a vaccine has already been developed, but it is only licensed for people aged 9-45 years in some countries. The WHO recommends that the vaccine should only be administered to people with confirmed previous Dengue virus infection. As we show in our paper, Dengue is currently spreading together with its vectors. The COVID-19 pandemic should serve to demonstrate that global pandemics are possible and, so, must be prevented.

 

What value did having access to global spatio-temporal data add to your study?  

GIDEON helped us to get quick access to the available information on the disease. This allowed us to build our databases in a short time and to validate our models with recent cases in order to assess the reliability of the tool we use and to predict new areas favorable for new Dengue cases.

 

What are your thoughts regarding data availability on sylvatic transmitted Dengue?  

Most of the available data on human cases do not differentiate whether they were caused by sylvatic or urban transmission. Some research studies in certain local areas may be able to determine this, but globally there is no such information. Our biogeographic outputs related to Africa and Asia are consistent with the scarce information available and provide the context in which on-the-ground prospections on sylvatic Dengue should be addressed. This is especially important in South America, where sylvatic Dengue has not been detected yet (although the presence of sylvatic Yellow Fever and other evidences are starting to suggest its existence).

Aedes aegypti Mosquito. Close up a Mosquito Mosquito on leaf,Mosquito Vector-borne diseases,Chikungunya.Dengue fever.Rift Valley fever.Yellow fever.Zika virus.
Aedes aegypti mosquito, the vector of Dengue

 

What areas do you think GIDEON could improve to make our data more useful to you in the future?  

We appreciate the great work GIDEON does in collecting data globally. We found the new GIDEON interface very useful. Perhaps it would make it easier in the future, if it is possible, to distinguish between imported and autochthonous cases within the database. It is true that in many cases the database does mention it but not for all countries.

 

About Alisa:

Alisa Aliaga-Samanez has a degree in Biology from the Federico Villarreal University (Peru) and a Master’s degree in Biodiversity and Environment from the University of Malaga (Spain). Currently, she is working at the Animal Biology Department of the University of Malaga, being part of the Biogeography, Diversity and Conservation Group,  developing her Ph.D. thesis. The thesis is focused on the study of primate biogeography, applied to conservation and human health. She is currently mapping vector-borne zoonotic diseases through global distribution modeling. 

Aliaga uses high-resolution global maps and the most up-to-date databases to analyze geographical changes in the risk of zoonotic disease transmission. In addition, in these analyses, she considers the biogeographical contribution of primates in increasing the risk of transmission. She seeks to determine the potential natural range of endemic and emerging zoonotic diseases in the world, with the aim of suggesting specific management strategies according to the spatial distribution of risk factors.

Click here to read the open-access article: Worldwide dynamic biogeography of zoonotic and anthroponotic Dengue 

 

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Disease Outbreaks and Economics: an Interview with Prof. Rodolphe Desbordes

“Our results indicate that factors fostering a disease outbreak in one country can quickly lead to the emergence of a disease outbreak in another country.”

Epidemic infectious disease outbreak with person analyzing virus strain and worldwide situation. SARS-CoV-2 pathogen causing coronavirus covid-19 pandemic disrupting social and economic life

 

In March 2021, the Journal of Mathematical Economics published a research paper, Spatial dynamics of major infectious diseases outbreaks: A global empirical assessment. The article explored the spatial dependence of outbreaks and the role of globalization, analyzing 20 years’ worth of major outbreaks in developed and developing countries. The study found empirical evidence that ‘local outbreaks of many different infectious diseases can quickly spread to other countries’. Mortality consequences were found to be ‘much more severe in developing countries’.

 

Economics professor Rodolphe Desbordes
Prof. Rodolphe Desbordes

We spoke with the author Rodolphe Desbordes, a Professor of Economics at SKEMA Business School, about the importance of this research and the reasons behind choosing GIDEON as the data source.

Prof. Desbordes has widely published in the fields of International Economics and Economic Development. His current research interests encompass applied econometrics, determinants of political regime changes, and the links between biodiversity, economic activity, and zoonotic diseases.

 

 

How did you find out about GIDEON? 

I was looking for data with worldwide coverage on outbreaks of infectious diseases. I was really surprised not to find this information easily (e.g. provided by the WHO). In a few papers, I noticed their use of GIDEON.

 

What were the reasons behind choosing the GIDEON database for your analysis? 

I am really an applied macroeconomist, often interested in very global issues. For this reason, I need databases with long (time) and wide (spatial) coverage to run estimations. GIDEON was the perfect database for the epidemiological project I had in mind. In addition, for a non-specialist, the information provided on each disease was crucial to a better understanding of disease-specific characteristics.

 

How could healthcare systems benefit from a more econometric approach? 

Adopting an econometric approach is useful to reveal broad patterns, isolate the effects of specific factors, and carry out projections. This type of approach must be done in conjunction with expert knowledge of local conditions.

 

What is the importance of taking epidemiological data into account in the context of international policymaking? 

Deming said that “without data, you are just another person with an opinion”. Data are essential to guide domestic and international policymaking. Lots of data still need to be produced, in order to strengthen surveillance systems.

 

Do you consider developed countries’ decision to donate COVID-19 vaccines a step towards achieving a GPG (Global Public Good), and do you see this becoming more commonplace?

Some people have argued that the current pandemic is a rehearsal for the coming climate change crisis. It is essential that developed countries stop acting as if they live on a different planet where bad things do not happen to them. An unfortunate advantage of global crises is that even self-interested rich countries contribute to the Global Public Good. However more needs to be done. Donating vaccines is an encouraging sign.

 

Do you believe the current pandemic will encourage a more global view of public health concerns and their associated impact on economies? 

This is a tough question! We have been warned repeatedly about the risks of emerging infectious diseases. But, unfortunately, we did not act to prevent global pandemics from happening. One may hope that we will draw out the right lessons from the current pandemic. However, I am skeptical. For policymakers, the future always seems far away and purely national issues much more pressing than uncertain existential risks.

 

What value did having access to global data add to your study?

As an applied economist, I value excellent data on a novel and interesting issue more than anything else. The GIDEON database allowed me to publish in an excellent journal and, most importantly, carefully model the spatial diffusion of infectious diseases in a globalized world.

 

How would you have gone about collecting the outbreaks data if the GIDEON database did not exist? 

One possibility would have been to exploit the Global Burden of Disease data. However, despite the provider’s best efforts, the reliability of these data remains uncertain, and diseases are aggregated in relatively coarse categories.

 

In your article, you mentioned the GIDEON database is under-exploited – do you believe it could further contribute to the field of Economics and how? 

Infectious diseases have now become a hot topic in Economics. For various reasons, including data availability, the effects of many diseases were neglected. I hope that my use of the GIDEON database will alert researchers to this incredible information source and encourage more epidemiological research.

 

Click here to read the open-access article Spatial dynamics of major infectious diseases outbreaks: A global empirical assessment

 

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Insurance risk solution powered by GIDEON data

man and woman health insurance

Read the full case study here

 

INCREASING EPIDEMIC FREQUENCY

There’s mounting evidence that the rates of infectious disease outbreaks have been increasing in frequency over the past few years. Perhaps even in the past two decades.

From the period of the Spanish flu pandemic in 1918 to the HIV/AIDS epidemic around 1981, there were only six pandemics on record. Approximately one per decade.

However, since the SARS outbreak of 2002, there has been an increased frequency of outbreaks.

The records show that SARS was quickly followed by several recurring and new outbreaks. AVIAN flu, MARBURG virus, SWINE flu, MERS, and EBOLA to name a few. 

COVID being the latest in the pattern of epidemics has grown into a pandemic. 

The world has gone from dealing with one serious outbreak every decade to dealing with a serious outbreak every couple of years. There have been 10 major outbreaks between 2002 and 2020.

 

IGNORING THE EVIDENCE 

Despite this growing trend, most companies didn’t consider epidemics a risk to their business.

The reason for this indifference to risk was simple. Pandemics that badly ravaged the world seemed isolated to the singular event of the Spanish flu. And this isolated event was about a century old. 

Added to this was the fact that epidemic insurance had little precedent as a product. And it is very complex to model and calculate. Coverage for business interruption due to communicable diseases was not typically offered by traditional insurance policies.

However, the situation now is that COVID-19 has changed all that. Organizations must prepare more carefully now given the recent impact of the pandemic. Knowing the historical records of the Spanish flu makes it prudent to prepare even more mindfully.

 

SEEING THE TREND 

Some insurers have taken notice of the increase in outbreaks of epidemics. 

Munich RE is a global provider of reinsurance, primary insurance, and insurance-related risk solutions. They took note of the increased rate of epidemic and pandemic events and started responding to the data. 

They decided to build a model that assesses epidemic risk. Building a model that allows for epidemic risk assessment is a very important part of developing insurance against that risk.

For this, they needed to have good data on infectious diseases over the past decades.

 

GIDEON DATA PAVES THE WAY TO A SUCCESSFUL MODEL

Munich RE employed GIDEON’s outbreak data in building its epidemic risk assessment model. It improved the accuracy and depth of their underlying data and the quality of their results.

Munich RE now offers Epidemic Risk Solutions to several industries including those that were hit the hardest by the COVID pandemic. 

GIDEON’s data paved the way for accurate models to assess risk and provide insurance coverage in the event of business interruption as a result of an epidemic.

This allows insurers to close a significant coverage gap that traditional insurance doesn’t.

With GIDEON’s disease outbreak data, insurers can make companies more resilient against business interruption due to an epidemic or pandemic. 

Companies have a stronger outlook now as epidemic and pandemic insurance has become a reality.

Read the full case study here

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Diagnosis tool of choice for 27 years

A group of infectious diseases clinicians standing together
GIDEON is ideally suited to assist infectious diseases specialists

 

Read the full case study here

Medical Doctors have a serious enough job to do when caring for people’s health. But when their patients have recently been to other countries this may increase the complexity even more.

They must get information on the current state of infectious diseases in the country where the patient has been. With over 200 countries worldwide, doctors would have to be walking databases of infectious diseases.

SITUATIONS MEDICAL DOCTORS HAVE TO DEAL WITH

For example, now the flight restrictions due to COVID are being eased, it is reasonable to expect that experts will once again be called out to go to other countries and help with their knowledge.

If these experts fall ill when they return home, their doctors will have the job of getting information on infectious diseases in the countries they had just visited.

This can be complicated by many factors. Limited data, remote destinations, similar symptoms for multiple diseases, and numerous diseases in the given country, etc.

These factors may also lead to misdiagnoses and mistreatment.

In fact, in the case of an Israeli agricultural expert who fell ill when he returned from India he was misdiagnosed several times. And of course, he was then treated for the wrong disease.

However, when his symptoms were entered into GIDEON he was correctly diagnosed and treated. He was discharged in good health a week later.

QUICK & RELIABLE INFECTIOUS DISEASES DIAGNOSIS

This is just one of the many reasons why Dr. Jeffrey P. Gumprecht says that GIDEON is irreplaceable.

Nothing compares to GIDEON for diagnosing infectious diseases. Especially when a person’s health and life are at stake.

Dr. Gumprecht puts some details into the interactive tool. Details like when a patient traveled to a specific country, when they returned, their symptoms, and the organ systems involved. That’s all GIDEON needs to generate a Differential Diagnosis.

It also enables him to share information with other infectious disease specialists. He says it’s an amazingly valuable source of information, helping users to quickly reach a diagnosis.

GIDEON – BETTER THAN A LIBRARY

Dr. Gumprecht prefers it to the Library at New York University because he can get a full description of any infectious disease from GIDEON.

As great as libraries might be, none of the online library platforms have diagnostic tools. Going to the library at best extends the patient’s suffering. At worst it costs critical time a patient might not have.

That’s why Dr. Gumprecht thinks nothing compares to GIDEON. It’s invaluable to have a solution where all of the information on infectious diseases is available in one place. It eliminates the need to go through multiple review articles or separate websites.

GIDEON is very beneficial to the infectious disease fellows at Mt Sinai hospital where Dr. Gumprecht works.

Read the full case study here

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Predicting the future with GIDEON data

Researcher and globe

Study the past if you would define the future.” – Confucius

If you want to study the past then GIDEON is a great place to do so. The question is, what would you do with over 750,000 data points, dating back to the 17th Century?

A team of researchers answered in a recent interview.

  • Tad Dallas, Assistant Professor at Louisiana State University
  • Colin J. Carlson, Assistant Research Professor at Georgetown University
  • Timothée Poisot, Assistant Professor at Université de Montréal

Idea

“The three of us have talked a lot about why predictions and ecology work or don’t work. We all share a lot of frustrations about where things fall short and how things get framed. We were having a conversation one day about what sort of minimum information is that you would need to know what the future looks like. Then Tad said: “I’m going to make a model with no predictors”. 

“It opened up this incredibly interesting question – What do we do with this model if it’s able to do predictions?”

How did the GIDEON data help with the study?

“We tried to make a completely predictor free model to just see if we can let the similarity of pathogen communities to inform prediction and see how this can influence the future.”

“The main question was to get a sense of what happens where and when it happens”, said Colin. “There isn’t any cohesive narrative about where outbreaks happen. We used the GIDEON data because we thought it might be the most complete thing there is.” 

The outcome

The team produced a research paper “Testing predictability of disease outbreaks with a simple model of pathogen biogeography“, published by The Royal Society in November 2019. It proved effective at making the disease outbreak predictions and was created using only GIDEON data. Impressive!

Predicting the future outbreaks - two diagrams

The value of data is only realized when it is put into context and made relevant to a particular problem or theory. You provide the context and the problem, and we’ll provide you with the data. How could GIDEON fuel your research?

Read the full case study here.

And don’t forget to follow us on Twitter, Facebook, and LinkedIn. We’ve got exciting updates about our new interface!

First alpha testing is complete!

Male doctor and female researcher testing GIDEON app

It takes a lot of courage to share a vision with users and critics, but the GIDEON team is in no short supply of that. In our recent alpha testing round, we opened up our brand new interface to medical experts from 25 countries who have very kindly shared their feedback on our successes and shortcomings.

What is alpha?

Quite simply, it is an early release of a major product upgrade. Our first alpha testing round focused on the display of our extensive database in a brand new ‘Explore’ module.

How did we do it?

We opted for feedback gathering mechanisms that support user independence and anonymity. This is different from a focus group, which is prone to leaving some opinions unheard. 

Our Trusted Advisors were a diverse bunch, consisting of 80+ medical professionals – from seasoned experts to students. Some testers have never seen our product before and others have been using GIDEON for years. 

The experience was scary, exciting, and necessary. We cannot thank our Trusted Advisors enough for their insight and valuable time spent exploring our new interface. The feedback has empowered a fruitful fine-tuning exercise, so if you are one of our testers – be sure to check out the implementation of your suggestions in the second alpha release!

Feedback

We are beside ourselves in anticipation of the release of the new interface (date to be confirmed soon) and based on the early feedback we know you are going to love it.

Here is a small sample of the comments we received:

This is a huge improvement. I very much like the general concept. The dark mode is also very nice.

Comprehensive.

Amazing work! So informative and pleasant to use.

Disease comparison is great. What a useful way to compare a differential!

I very much like the ‘fingerprint’ search concept for diseases.

The interface is easy to use.

Maps are amazing!!

Thoughtful, cohesive design.

Links to references are very useful.

What’s next?

We cannot wait to share this new experience with you all. It’s the same GIDEON data that you know and love, but like you’ve never seen before. 

If you are interested in a Bayes-powered Differential Diagnosis that uses one of the most impressive geographical medicine data sets in the world, sign up to test the all-new DIAGNOSE module. The second alpha is just around the corner!

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Doody’s Collection reviews GIDEON

An in depth review and overview of GIDEON by Wladimir Labeikovsky is a feature article in the Doody’s Collection newsletter.

 

 

Review of GIDEON Guide to Antimicrobial Agents

Aug-2014-MT-Cover-headerThe Microbiology Society (formerly SGM) published a good review of the ebook, GIDEON Guide to Antimicrobial Agents, in Microbiology Today August 2014 issue.

Laura Bowater, the Editor, wrote:

I was able to find my way around the information quickly and easily … it is a comprehensive reference book that provides up-to-date accessible information. This format may particularly benefit those accessing it via a mobile phone. I can understand why it would work well in a clinical setting too.

It should be noted that the ebook is available separately from, and does not require a subscription to GIDEON.

Ebooks review in Clinical Infectious Diseases

GIDEON ebooks series review by Dr. Mary Wilson, Associate Professor of Global Health and Population, Harvard School of Public Health has appeared in the journal Clinical Infectious Diseases (CID 2010; 51(10):1227–1228).

Some excerpts:

[GIDEON] has now developed the GIDEON e-books system. This massive database, 411 books with 95,000 pages, presents material in 2 formats, by country and by infectious disease. Data are culled from papers published in journals, textbooks, Health Ministry publications, and materials from the Centers for Disease Control and Prevention and the World Health Organization.

The advantages of the system are many. It is an extraordinary database. It assembles a vast amount of material and makes it available in a consistent format.

GIDEON review in Travel Medicine and Infectious Disease

Dr. Stephen Toovey wrote a nice review of GIDEON in the Travel Medicine and Infectious Disease journal. He says “…there is no doubt that travel medicine practitioners, infectious disease physicians and microbiologists in need of a serious database will have to consider Gideon”

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